After Trumpcare, Medicare Part M

Here’s a thought: as soon as we defeat Trumpcare, Democrats in both houses introduce Medicare Part M (for Middle-Aged), covering people ages 50-64.

A. It’s good politics:

1. These are the people who were going to be hit the hardest by Trumpcare premium increases. Offer them a better deal and they’ll support us–and people this age vote!

2. It sounds more moderate than Medicare for All, while also making a solid step closer to single-payer, which the Republicans have managed to make sound like pie-in-the-sky socialism with a side order of end-of-the-world.

B. It’s good policy:

1. These are the sickest people in the Obamacare exchanges–move them out of the pools and premiums go down.

2. BUT they’re healthier than most people now on Medicare: put them into that risk pool and the premiums go down there, too.

DON’T believe Trump when he says Obamacare is collapsing.

DON’T believe pundits who say the Democrats have no platform/positions: this plus increased minimum wage plus let’s get out of Afghanistan is platform a-plenty.

Author: Kelly Kleiman

ï»¿Kelly Kleiman is a freelance writer on the arts, feminism, travel and social justice. Her reportage and essays have appeared in the New York Times, Wall Street Journal, Washington Post and Christian Science Monitor, among other dailies; in magazines, including In These Times and Dance; in the alternative press; on the BBC; and on Chicago Public Radio, where sheâ€™s one of the â€œDueling Criticsâ€ and a contributor to the Onstage Backstage theater blog. She is also a consultant to charities and editor and publisher of The Nonprofiteer, a blog about charity, philanthropy and nonprofit management. She holds undergraduate and law degrees from the University of Chicago.
View all posts by Kelly Kleiman

23 thoughts on “After Trumpcare, Medicare Part M”

Sounds a lot like the recipe for tramp stew that begins with the immortal words: first steal a chicken.

The bulk of the wavering Republican votes in the Senate are those who think the bill isn't mean enough. Maybe they'll get some of what they want in conference with the House but they're basically on board with the bill.

The others are the so-called "moderates". As Josh Marshall says, it's an iron law of politics that the Republican moderates always fold. They may posture for awhile but they always fold. Always.

There's a twist to the iron law. It looks as if the moderates are demanding more time for posturing before folding. Johnson and Collins have both said an early vote is unlikely, so the vote may well be put off. That seriously damages the bill's chances, as time allows grassroots opposition to mobilise round the inevitably terrible CBO score.

McConnell's plan for a stealth repeal relied on a quick vote, which he may not get. McConnell may also be subject to certain institutional myopia, in that his primary concern is keeping Republican control of the Senate and judicial appointments, leaving the House GOP to look after its own concerns. Republicans are much more vulnerable in the House in 2018 than in the Senate. The grassroots opposition will attack them in both: the bill needs the jellyfish in both houses to pass.

Is universal Medicare really off the table? This is the logic of Ezra Klein's reasoning that Trumpcare implies that Democrats must stop seeking bipartisan solutions as Obama did and propose simple policies that will mobilise the silent majority. The relative political strength of Social Security and Medicare over Medicaid suggests that Americans are more comfortable with a Bismarckian social insurance model, as in France and Germany, than with a Beveridge national health service funded directly and more progressively by national taxes (as in the UK and the Nordic countries). The debased rollover of the US health insurers on Trumpcare, in contrast to the opposition of the health providers, has forfeited any moral claim they may have had to consideration.

And if it really has to be gradual, you could also turn S-Chip into Medichild for all newborns and extend the coverage year by year. Oh, and include pregnancy and maternity care: care from conception. This is good money-saving policy and would annoy the antiabortion warriors no end.

Maybe the right political calculus is to *propose* Medicare-for-all as the initial bargaining position, but be willing to fall back to something more like Part M. But don't waste energy negotiating with ourselves.

(I suppose there's a danger that starting with single-payer would inflate the hopes of the faction that regards anything less as a betrayal, and they'd team up with the right to destroy anything that sounds like less.)

I think at this point proposing single-payer upfront and then retreating from that position would be the kiss of death. It would make the eminently sensible positions proposed in the original post seem like a way of sneaking single-payer in via the back door. (Yes, yes, I know, but at the present moment single-payer from the get-go is dead in the water.) I'm fairly sure the OP positions are likely to be popular on their own if presented clearly enough and with an eye to the voters who need to be and can be convinced. I particularly like the appeal in each case to the self-interest of the group in the middle–their premiums will go down if the 50-64 bunch is moved out of the exchanges and onto Medicare–as well as the self-interest of the 50-64 population.

One problem with the ACA as presented is that it was clearly the result of a lot of negotiation, so the sausage could be seen unpleasantly being made. Taking a strong "Medicare for ages 50-64" stand and sticking with it stands a better chance given the current Congress, I think.

I'm all for universal health care of some sort, but I can't go along with a system of blank checks for such health care, or the other extreme of price controls. These will just end up eventually either degrading service or transferring all wealth to health care providers and the administrators of same, with no assurance of more or better care. Honestly, we would be better off just repealing Obamacare and relying on charity again.

OK. Compulsory insurance with community rating. Government subsidies of premiums when they exceed a certain percentage of income. Price controls. Government-specified required minimum benefits. Copays limited to $429/yr (in 2014, per wikipedia) and deductibles chosen by the buyer, from $184 to $1534/yr. Various other government interventions. Premiums of a few hundred dollars a month.

If it is truly a negotiation, rather than the government acting as an enforced monopsony (i.e., the only allowable purchaser), then there is little or no difference. In that case, the provider is free to walk away from the deal and negotiate with another buyer. But if the government is the sole purchaser and can say "Take this price or go out of business", then it is not a negotiation, but price control. And there are intermediate situations, such as Medicaid, where providers are free to refuse, but are thereby precluded from so much of the market that their freedom to refuse is de facto minimal rather than de jure precluded.

OK, at first, I thought this was sarcasm. But then, looking at aajax's comment-history, I see that he's actually serious! Amazing! Poe's Law strikes again! Of course, no point in arguing with him. But just … wow, didn't expect to see such a lovely instance of Poe's Law.